OP0052 THE EFFECT OF TOFACITINIB ON RESIDUAL PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS WITH COMPLETE CONTROL OF INFLAMMATION
Authors: M. Dougados, P.C. Taylor, C. Bingham, L. Fallon, Y. Brault, S. Roychoudhury, L. Wang, M. Kessouri
Journal: Annals of the Rheumatic Diseases (2022)

<h3>Background</h3> Residual pain often remains in patients (pts) with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who achieve low disease activity or remission.<sup>1,2</sup> Tofacitinib is an oral JAK inhibitor for the treatment of RA and PsA. A descriptive analysis showed that tofacitinib may have a beneficial effect on residual pain in pts with PsA with abrogated inflammation.<sup>3</sup> <h3>Objectives</h3> To assess efficacy of tofacitinib, adalimumab (ADA) and placebo (PBO) on residual pain in pts with RA and PsA with abrogated inflammation, using a network meta-analysis (NMA). <h3>Methods</h3> Data were pooled from 9 randomised clinical trials of pts with RA (NCT00960440/NCT00847613/NCT00814307/NCT00856544/NCT00853385/NCT01039688/NCT02187055) or PsA (NCT01877668/NCT01882439). This analysis included pts who received ≥1 dose of tofacitinib 5 mg twice daily (BID), ADA 40 mg once every 2 weeks or PBO with background therapy, and had abrogated inflammation (swollen joint count [SJC] = 0 and C-reactive protein [CRP] &lt;6 mg/L) at Month (M)3. ADA was included in NCT00853385/NCT02187055/NCT01877668; NCT02187055 performed tofacitinib/ADA non-inferiority/superiority comparisons. Primary outcome was pt assessment of Pain (visual analogue scale [VAS] 0 [no pain] – 100 mm [most severe pain]) at M3; scores were summarised descriptively; treatment comparisons were assessed by Bayesian NMA on individual pt-level data, accounting for within-trial imbalances and treatment effect modifiers. <h3>Results</h3> Abrogated inflammation at M3 was achieved in 14.1% (328/2330), 14.9% (87/585) and 3.0% (20/673) of RA and 22.7% (54/238), 29.2% (31/106) and 12.7% (30/236) of PsA pts receiving tofacitinib, ADA and PBO, respectively. RA and PsA pts receiving tofacitinib/ADA had higher CRP vs pts receiving PBO. RA pts receiving tofacitinib/ADA had lower SJC and longer disease duration vs pts receiving PBO. PsA pts receiving tofacitinib had a longer disease duration and higher Pain VAS vs pts receiving ADA/PBO. In both groups, a lower % of female pts received tofacitinib/ADA vs PBO (Table 1). Observed median (Q1; Q3) values for Pain VAS at M3 were 17.0 (6.0; 31.0), 19.0 (7.0; 31.0) and 33.5 (7.0; 48.0) in RA and 24.0 (8.0; 44.0), 21.0 (9.0; 49.0) and 27.0 (8.0; 52.0) in PsA pts treated with tofacitinib, ADA or PBO, respectively. Differences between active treatments and PBO were less prominent in PsA vs RA pts, per posterior probability values (Fig). <h3>Conclusion</h3> In this NMA, pts with RA and PsA achieving abrogated inflammation with tofacitinib or ADA at M3 had greater residual pain reduction vs those receiving PBO. This may imply that tofacitinib/ADA have analgesic benefits beyond those related to inflammation reduction. <h3>References</h3> [1]Michaud et al. Arthritis Care Res 2021; 73: 1606-1616. [2]Kilic et al. Rheumatol Int 2019; 39: 73-81. [3]Dougados et al. Arthritis Rheumatol 2019; 71 (S10): Abs 1502. <h3>Acknowledgements</h3> Study sponsored by Pfizer Inc. Medical writing support was provided by Lewis Rodgers, CMC Connect, and funded by Pfizer Inc. <h3>Disclosure of Interests</h3> Maxime Dougados Consultant of: AbbVie, Eli Lilly, Gilead Sciences, Janssen, Merck, Novartis, Pfizer Inc and UCB, Grant/research support from: AbbVie, Eli Lilly, Gilead Sciences, Janssen, Merck, Novartis, Pfizer Inc and UCB, Peter C. Taylor Consultant of: AbbVie, Biogen, Bristol-Myers Squibb, Celltrion, Eli Lilly, Fresenius, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Inc, Roche, Sanofi and UCB, Grant/research support from: Celgene and Galapagos, Clifton Bingham Consultant of: AbbVie, Bristol-Myers Squibb, Gilead Sciences, Eli Lilly, Janssen, Pfizer Inc and Sanofi/Genzyme, Grant/research support from: Bristol-Myers Squibb, Lara Fallon Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Yves Brault Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Satrajit Roychoudhury Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Lisy Wang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Meriem Kessouri Shareholder of: Pfizer Inc, Employee of: Pfizer Inc.